Wednesday, September 2, 2009

Paradigms shift rapidly in antipsychotic treatment

Henry A. Nasrallah, MDEditor-in-Chief

Like the “paradigm shift” Thomas Kuhn coined in his seminal book, The Structure of Scientific Revolutions, paradigm shifts have been occurring at a breathless pace in psychiatry. Thanks to ongoing research, changes in the clinical standard of care for schizophrenia in the past 20 years are a case in point.

Let’s take 1988 as a starting point. That’s when clozapine was “resurrected” as the only drug with proven efficacy in refractory schizophrenia after several first-generation antipsychotics (FGAs) had been tried. However, because of its potentially fatal side effect (agranulocytosis), clozapine was designated as an absolute last-resort agent. It also was stigmatized for its many other side effects, including serious metabolic complications.

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